rock_shoes

Why so much fluid so fast? I'd want to start with 500mL NS, re-auscultate and get another BP before giving any more than that. Did we get a rhythm strip? Also let's get another BGL before sticking a tube down the kids throat on the off chance his sugars are still low (I realize this is unlikely with that amount of D50). Also did we check the kids pupils yet? (I mean since the arrival of ALS)

We don't have any rules about sleeping during slow parts of the shift. It all comes down to respect. Respect for ones fellow co-workers and respect for the profession. Our station duties are done and the in-coming crew is respectful of the outgoing crew when they may have been busy their entire shift. What's needed is professionalism not rules.

Fresh set of vitals. If the sugar is still low after the glucose given by the FR put some dextrose through the IV and bring it into the acceptable range (Don't forget the Thiamine). Whats the patient's GCS with the his sugar brought back up?

What's his temp? Does he have any family you can get more of a medical history from? Perhaps a team medical form you can draw from? Do you at least have an OPA or NPA you can stick in while waiting for ALS?

My apologies katbemeEMT-B. I read disagree not agree. Guess that's what happens when you're on nights for weeks at a time.

A good EMT who is noticing a problem such as inadequate handling of sharps will mention the problem to there partner and take action to help their partner in correcting the problem. Failure to do so is an inadequacy of the EMT. I realize Dust can be a little abrasive in how he says things at times but he is still correct with regards to this issue.

I agree. It would be good to get an outside perspective from a different system. Any Aussies, Kiwis, Americans etc. are welcome to comment.

Well that’s the big question of the decade don’t you think? I suspect the enactment of the AIT will force the issue whether BCAS or EMA licensing like it or not. EMA licensing will either enact the full scope of practice for the various levels or those of us who insist on working to the full scope of our education will license in other provinces. Then through the AIT we will be able to return to BC and work under that license. It’s safe to say all of us are looking forward to the end of that era. I don’t think these people should be allowed to wear clothing that identifies them as “Paramedics” but BCAS has failed to come up with separate uniform issue for these people. The excuse typically used is that ambulances in some areas wouldn’t have enough people to staff the cars without the use of driver only’s. I say put some onus on the communities in these circumstances. If the ambulances go down someone will step forward. I think the only lobbying anyone is going to be willing to do in BC in the immediate future is for wages and benefits. Our contract expires spring 2009 and we’ve slipped a long ways from where we once were relative to other emergency services in BC. Long term I think the licensing body that will eventually be formed needs to be completely separate from the union. I sometimes wonder if we are in an appropriate union as part of CUPE. It seems like we are an afterthought in the bigger picture of CUPE. They will have my support in seeking a better contract but I’m certainly willing to ask questions along the way. Blindly following never got anyone anywhere worthwhile. www.firstaid.ca . The website is in dire need of an update. The demand for their programs has been high due to expected recoil from the JI. Now that there is finally another option in BC many are fleeing from the JI as fast as they can. Their website has fallen by the wayside in the mean time. Yup. Asinine is definitely the right word. You guys in Alta. are in for just as much or more of a roller coaster ride as we are in BC. I hope for the people of Alta. that it doesn’t lead to a degradation of service in more rural areas. I wouldn’t be surprised if there is a bit of a row in store for CUPE 873 before the end of our next bargaining agreement. I expect to see the upper level union members see some turnover for better or worse in the not too distant future. There most certainly are a number of incidents deserving of ALS attention. The best method I can think of to force the issue is for as many of us as possible to bring ourselves up to the ALS level. If enough of us are ACP providers to staff more ALS cars BCAS will be incapable of finding an excuse for the lack of ALS cars on the road. I say fight the system with education. I don’t know the process for becoming a paramedic alderman. Sounds like a good way to work for progress to me. My focus at the moment is educating myself to what I feel should be the standard available to citizens. I’d be more than happy to drop a line in the water with you when you make it out this direction. Ed

I really like the 5.11 Tac-lite pants. Just my personal preference of course. They aren't cheap but I find them comfortable and functional. with nice flat pockets.

People licensed as PCP do not meet these competencies you are quite correct. Anyone licensed as a PCP-IV meets these competencies except for conducting and interpreting 3-lead ECG’s. All of us who went through a PCP program (not a P1 or EMA2 program) know and can meet this competency without additional educational time. Licensing has failed to add it in spite of the fact that we are now taught this competency. This particular issue is a failure in licensing not in education (not that I don’t recognize the existence of far better schools than the JI). I don’t like it either and the sooner we can change it the better. As for the elimination of the EMA FA level that will happen by attrition. Prior to fall 2006 the licensing branch ceased to license people at that level forever. Anyone licensed as an EMA FA can not renew their license and licenses expire every 5 years. Therefore the last EMA FA will be gone the way of the Dodo bird by fall 2011 at the absolute latest. As things currently stand an EMA FA can not attend on car and is relegated to driver only. Yes I know what you’re going to say about this. The existence of driver only people on car is a horrendous failing of the system. I agree completely on that point. Both the JI and EMA licensing are huge hold backs. Unfortunately the BCAS itself is an even bigger hold back. EMA licensing essentially uses what BCAS lays out as it’s requirements to set licensing standards. The more expansive the licenses become the more it’s going to cost to keep us around. Let’s just say BCAS brings new meaning to the word cheap. Our dismal ALS capture in BC is a prime example of that. The guys/gals we have doing ALS are great. We just don’t have anywhere near enough of them. The JI is finally receiving some competition. The Academy of Emergency Training has been running EMR, and PCP programs for a while now with better success rates through licensing and the students preferred by the on car preceptors. AET is also in the process of developing an ACP program so the competition is finally starting to come forward. In the mean time I’ll be taking the JI’s new ACP pre-requisites because I believe they are actually sensible pre-reqs. Whether or not I will go to school at the JI remains to be seen. I fully intend to use the AIT to my advantage and shop around for the best school I can find no matter what province it happens to be in. This particular failing belongs to “Worksafe BC” not BCAS or EMA licensing. I have to do the same bridging course to work in industry myself in spite of being licensed in BC. It’s absolutely ludicrous. My EMR license was recognized as OFA 3 equivalent but my PCP-IV license will not be. The course is a one day, show up and pass, BS session that will cost you a couple hundred bucks. I’ll end up taking it so that I can work in industry but you can bet I’m far from happy about it. To work to full scope in BC industry you need, a BC EMA license (as an EMR, PCP, PCP-IV, ACP, or CCP), the OFA 3 bridge, and a medical director to sign off on your scope. You must mean hopeless optimism? Yeah I’m probably guilty as charged there. I’m a stubborn bugger and if things are going to change that’s exactly what we need. I just hope it isn’t misplaced. No harm no foul. I’m a little too thick skinned to take things that way. Both of us are looking to improve things nationally for everyone. We may not always agree on the best way to do that but we’re both after the same goal. The protection of title issue is a prime example. I wholeheartedly agree that we need protection of title. I just don’t agree with one province using different titles than every other province. In the end I don’t care all that much what the titles end up being. I just care that they are uniform across the nation and protected. Personally I like the old EMA titles we used here in BC. EMA I, EMA II, EMA III. They were simple and to the point with no mistaking which was the higher level of attendant. Also they where protected titles in the province of BC. I actually found EMT city through a My Space link. Probably the last time I was ever on My Space as I quickly learned it was pretty lame. At the moment I’m mainly working out of station 318 in Lillooet but I’ll soon be transferring over to station 324 in Merritt. My home town. Long term I’m destined to end up in either Kamloops or Kelowna with those being the 2 closest cities with ALS. That’s if I remain with BCAS of course. I’m not making any definite plans to do that at this point. Ed

Well Tniuqs I'm going to have to bite on this one. A true PCP in the province of BC is in fact IV endorsed. Just for everyone wondering how we have people in the province of BC who hold EMA licenses that say PCP yet they cannot do IV's here is the story. At one point the BCAS in its wisdom decided that all of the EMA 1 attendants (equivalent to EMR using current terminology) needed be able to do more on car. To do this they put the majority of these people through a program called Paramedic 1. Unfortunately they essentially gave these EMR's a bunch of PCP protocols (minus the IV protocols) without the proper education to go with them. When the titles and occupational profiles where changed nationally these people where left in limbo. Not really PCP's but more than EMR's. Some of these P1 attendants have bridged into full PCP's (same idea as gap training in alberta) others have not at this time. Instead of calling them EMR's with specific license endorsements EMA licensing elected to call them IV restricted PCP's. EMA 2's were people brought to the PCP level before the P1 program and before the PCP program. The remnants of the P1 program are one of the biggest things holding us back from working closer to the full national PCP profile. Any of us who have actually gone through a true PCP program have been instructed to the national profile. As for the EMA FA remnants they are very soon to be gone. Nearly all of them are gone now and none of those who remain will have there licenses renewed. The only option for these people is to upgrade to EMR or relinquish their licenses all together. On the note of a self governing body that too is coming. The legislation has already been passed. The body has not been formed yet. BC hands down is one of the provinces that needed the most change and finally it is starting to come. At one time you had to be employed by the BCAS to hold a license in BC. That is no longer the case. Just one of the many steps needed to improve things. The changes are happening everywhere in Canada and overall they are good. Educational standards are increasing and the days of slapping on the O2 and running for the hills are well on there way out. Just not soon enough for my taste.

That's an interesting tact to take in using someones references Dust. I've never known someone to do that. I like the idea of doing whatever you can to get a better idea of what a prospective employees career aspirations are.

That is exactly how it should be everywhere.

If you are a lousy prospective employee you won't be able to find 3 references to use. It's just a quick start for HR to check references. If you're short on references or your references are bogus the application you put in gets round filed and it saves them the time and effort required to bring you in for an interview.

I had no idea these funeral home/ambulance services still existed. Sounds like these folks worked very hard to provide the best service they could with what they had.

I think the better tact would be to protect the PCP, ACP, and CCP titles and bring the province of Alberta into line with the rest of the provinces. I do understand and agree with the idea of protection of title but I still think the title and scope should uniform across the country.

Yep I made a nursing home neglect/incompetence run during my PCP precepting that I'll never forget. We're called to a Nursing home for a 76 y/o female IDDM patient with a decreased LOC. We do our initial assessment and low and behold her BGL registers as low (below the range of the glucometer). So we start a line, run 100mL of D10W into her with 50mg of Thiamine and she perks right up with a BGL of 6.2mmol/L. As we look at the patients care record and question the RN in charge we discover the cause of the sudden low. The RN gave this patient 40 units of Humulin with a starting BGL of 3.9mmol/L when the patient's BGL usually registers around 11mmol/L. All this and the patient had yet to eat that day. I guess this particular nursing home is where the bottom feeders of the nursing class end up.

No worries about failure to wear appropriate kit here. I wear the high visibility vest. Puke neon green with big wide reflective strips.

My service has a no cell-phone use while driving policy. It happens to be one of the policies I wholeheartedly agree with. If your service doesn't have a similar policy it needs to create one.

I don't really care about photography when I'm at work. I care about not getting hit by a car.

No child left behind strikes again! :shock: Wow am I glad we let the kids who aren't willing to put the work in fall behind here. Anyone who isn't classed as mentally handicapped can get through basic algebra if they put the work in. Kudos to you for going out and getting the knowledge on your own Dust. I agree with you that the little drug formulae are junk when some simple math is so much more accurate.

Did you really have to attend college to learn algebra for drug calculations? I had to learn that much algebra and more to finish high school. Are these differences between the US and Canadian public education systems or are they differences of generation? I can't really say but I must admit I'm curious.

Only a few flight paramedics have reflective pant stripes in BC. I do think they are a good idea if you have the option though.

The degree programs I've seen so far are geared towards management almost exclusively. The rumours at this point are that the JI's program will split in to two streams following the ACP. One a management degree program. The other a practicioner program. I have taken a quick look at the AIT. It's going to be an interesting couple of years! In the mean time what's it like coming over to the patch as a PCP? I did it as an EMR for a stretch and it was a real pain. Do you still have to go through the entire ACoP process or is there an expedited process for those already licensed in other provinces (in light of the upcoming AIT)? I still prefer working a public emergency cars but I need to bankroll my next stint in school.

I'll keep that in mind Tniuqs. At this point I'm going to take my lumps and do the new pre-requisites. I think that overall they are a step in the right direction and I want to support these kind of movements even when it costs me to do so. If nurses can have a bachelor's degree program then so should paramedics who have to be able to function as independent providers right from the word go. The responsibility placed on paramedics is enormous for the educational requirements overall. I want to see the education meet and exceed the level of responsibility.